Provider Demographics
NPI:1285115873
Name:JOHNSON, EMMONIA DENISE (LPN)
Entity type:Individual
Prefix:
First Name:EMMONIA
Middle Name:DENISE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:EMMONIA
Other - Middle Name:DENISE
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:13307 BABBITT ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77034-2173
Mailing Address - Country:US
Mailing Address - Phone:832-792-1931
Mailing Address - Fax:
Practice Address - Street 1:1735 ROCK RIDGE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77049-1464
Practice Address - Country:US
Practice Address - Phone:832-792-1931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX193755164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193755OtherNURSING LICENSE
LA007107004OtherDRIVERS LICENSE